Managed care insurers now have an economic reason to diagnose Celiac Disease

One of the barriers to awareness and diagnosis of Celiac disease has been the lack of enthusiasm on the part of health insurers. Now things have changed, and it is about time.

The Journal of Insurance Medicine has published a Celiac economic study by the Celiac Disease Center in Columbia that shows a decreasing cost after diagnosis.

"Researchers led by Dr. Peter Green, a professor of clinical medicine, said their study of a large managed-care database revealed cost reductions after diagnosis of celiac disease were attributable to decreasing trends in utilization of office visits, laboratory tests, diagnostic imaging and endoscopy procedures. "

This study is years overdue (see this two year old post including insurers), and it finally gives managed care insurers an economic reason to make sure all Celiac disease sufferers in their populations are diagnosed.

As a next step, I hope to see data-driven suggestions from these insurers soon. For example, it would be cheap and effective for them to send an email to segments of their population saying something like, "You have chronic iron-deficiency anemia. The differential diagnosis for that condition includes Celiac disease. Have you discussed it with your doctor?"

Does Steve Jobs, Apple's CEO have Celiac?

I saw a post on the Motley Fool site about Steve Jobs. Mr. Jobs has lost a lot of weight recently. He is CEO of a major company, and Apple doesn't have much in the way of a succession plan, so even the Wall Street Journal is interested in his health.

It is not a stretch from a numbers perspective. One has to figure that there are probably four to seven CEOs of Fortune 500 companies having to work with the issue, whether it is known by them or not. (It may be that the effects of being an undiagnosed Celiac keeps people from the top job).

There were two things that I thought were interesting about the article. One was the "oblique" reference to Celiac. By "oblique" I mean that Celiac was mentioned, but it wasn't the focus of the article. It was mentioned as an aside, and I think that is a great development for Celiac awareness. The second item of was and continues to be Steve's struggle to maintain his medical privacy in the face of legitimate investor concerns. Can anyone imagine how difficult a situation it would be where you didn't feel comfortable telling your co-workers you have Celiac? Personally, I made the decision a long time ago to tell everybody. But what is good for me and what is good for Steve Jobs are two different things. Sometimes it is hard to be a celebrity.

Wednesday Update. A Time magazine posting mentioned Celiac as a possible cause.

Oprah goes gluten free?

I was telling my sister how I was going to do a blog on some important legislation that passed recently, when she told me that Oprah is going gluten free. Say what? Well, after some research it turns out that she's just doing it as part of her 21 day cleanse, but there's a big part of me that really doesn't care if she's in it for the short term. Oprah is a monster-juggernaut commercial phenomenon - just look at what she did for the books in her book club. She's done some recent stories on links to autism and Celiac as well.

And for roughly 1% of the Americans that do the cleanse, there will be one Celiac that will probably note a remarkable difference and perhaps seek help. Go Oprah!

Elite Athlete surges after diagnosis

I saw this article on Pubmed about a college volleyball player who was diagnosed with Celiac her sophomore year. Several things interested me about her case.

1. She had a low hemocrit count on her complete blood count (CBC) before she was diagnosed. Me too.
2. She fell asleep at all times after intense workouts before she was diagnosed. Me too.
3. She lost about 20 pounds on her way to a diagnosis - and the medical team thought she had an eating disorder. That didn't happen to me, but it really irks me that medical teams go to anorexia and bulimia right away. Celiac is pretty common, too.
4. They thought it might be cancer. Me too.
5. She rebounded and surpassed her original fitness level after diagnosis and going on a gluten free diet. Me too.

What I'm thinking may be useful here from a medical perspective is the low hemocrit count and the sleeping thing. In athletes (and others?) the hemocrit may presage (or present with) the illness. This is critically important, because doctors will order a CBC for just about anything, but not a Celiac panel. As far as the sleeping goes - I recall the moment I realized I was really improving was the Saturday I did my 15 miler followed by activities with the kids all day, followed by a date with my wife (concert). As I was sitting in the chair at 10:30 pm, I realized I hadn't needed a nap that day. In the past, 15 miles had meant at least a two hour nap.

So my (not a doctor) advice for you is that if you need sleep after your workouts and have a low hemocrit count, get tested for Celiac. Any medical researchers want to pick this up?

Myopathy raises chances of Celiac

Just like IBS increases one's chance for a Celiac diagnosis, so does Myopathy.

Thus, celiac disease is more prevalent in patients with inflammatory myopathies than in the general population. -- Selva-O'Callaghan and colleagues (Muscle & Nerve, 2007;35(1):49-54)

If you have any friends with muscle weakness or inflammation, you might want to let them know.

Speaking of inflammation, I ran my workout a little too hard again today. Tomorrow, I'll be doing a bicycle ride north of Houston. Time to go prep. It should be fun.